B. DISCLOSURE OF RISK AND RELEASE FORM
Diving Voluntary Acknowledgement of Risks, Release of Liability and Indemnity
First Name
Last Name
Middle Initial
Street Address, City, Province and Postal Code
Age
Emergency Contact Name
Emergency Contact Telephone
PLEASE INITIAL
ALL BOXES
TERMS OF USE
DIVING IS AN IMPACT SPORT AND HIGH RISK RECREATIONAL ACTIVITY. MAY
RESULT IN PHYSICAL OR MENTAL INJURY, ILLNESS OR DEATH.
This document affects your legal rights. By writing your signature below, you acknowledge that you have read and understood
the disclosures of risks, voluntarily and agree to be bound by all terms of this Release of Liability and indemnity Agreement.
My signature acknowledges that I or the minor for whom I am a legal guardian (collectively referred to as “I”, “me”, or “my”) have
voluntarily chosen to participate in diving and to use the facilities at Eastlink center.
ACKNOWLEDGEMENT OR RISKS: I UNDERSTAND AND ACKNOWLEDGE that the Activities in which I am about to voluntarily engage
bear certain known risks and unanticipated risks that could result in PHYSICAL OR MENTAL INJURY OR DEATH, ILLNESS OR
DAMAGE to me or my property. I understand and acknowledge those risks may result in claims against Releasees. However, I am
making an informed choice to voluntarily accept such risks due to the thrills, excitement and benefits of the Activities, and I agree that the
benefit of the Activities outweigh the risks, which include but are not limited to:
(1) The acts, omissions or negligence in any degree of Releasees, or their agents or employees; (2) the risks inherent in the Activities,
including but not limited to and injuries such as a) broken bones, b) dislocations, c) torn ligaments and tendons, d) sprains and strains, e)
cuts to the head, body and/or limbs, f) torn nails, and g) bumps and bruises suffered while riding suffered while riding these extreme
sporting attractions; (3) latent or apparent defects or conditions of the Activities or the Facilities; (4) improper or inadequate instruction or
supervision regarding the Activites or use of the Facilities (5) the behavior of co-participants; (6) accidents or incidents in the Facilities,
including but not limited to accidents or incidents in wet areas, such as pool decks, tiled, concrete or other wet surfaces; and/or (7) first
aid, emergency treatment or services rendered or failed to be rendered by Releasees, or their agents or employees.
I UNDERSTAND AND ACKNOWLEDGE that the above list is not complete or exhaustive, and that other risks, known or unknown,
identified or unidentified, anticipated or unanticipated may also result in injury, death, illness, or damage to me or to my property. I
FURTHER ACKNOWLEDGE that I am in good physical and mental health, and not suffering from and condition, disease or disablement
which would or could potentially affect participation in the Activities or use of the Facilities. Further, I acknowledge that I am not
purchasing or leasing the attraction, but rather, am being offered a non-exclusive right to use the attraction. Additionally, I acknowledge
that Releasees are providing recreational services.
VOLUNTARY ACCEPTANCE AND ASSUMPTION OF RISK AND RESPONSIBILITY: I EXPRESSLY AND VOLUNTARILY AGREE,
COVENANT AND PROMISE TO ACCEPT AND ASSUME ALL RESPONSIBILITIES, AND RISK FOR INJURY, DEATH, ILLNESS OR
DAMAGE to me or to my property arising from the participation in the Activities or use of the Facilities.
RELEASE AND INDEMNITY: I VOLUNTARILY RELEASE AND FOREVER DISCHARGE AND COVENANT NOT TO SUE Releasees
and all other persons or entities affiliated therewith, from any and all liability, claims, demands, actions or rights or action, which are
related to, arise out of, or are in any way connected with the participation in the Activities or use of the Facilities, including, but
specifically not limited to any and all negligence or fault of Releasees. I UNDERSTAND THIS IS A RELEASE OF LIABILITY THAT
IS VALID FOREVER, and will apply to all current and future participation in the Activities or use of the Facilities.
I FURTHER AGREE, AND COVENANT TO HOLD HARMLESS AND TO INDEMNIFY Releasees, and all other persons or entities from
all defense costs, including attorneys’ fees, or any other costs incurred in connection with claims for mental or bodily injury,
wrongful death or property damage that may be filed by me, my child, me heirs, or my estate. Such indemnity and defense
obligation shall further extend to any claim, loss or lawsuit which alleges that I negligently or intentionally caused and injury,
death or damage to spectators or other third parties in the course of my participation in the Activities.
PhotoGRAPHIC IMAGE RELEASE: I agree to a blanket release of all my audio, video, and photographic image rights arising out of my
participation in or around the Activities and I hereby grant the Releasees the right to use my audio, video, and photographic images in
perpetuity (no matter by whom taken or recorded) in any manner for publicity, promotions, advertising, marketing, trade or commercial
purposes, without reimbursement of any kind due to me or the need to pay me any fee whatsoever.
ENTIRE AGREEMENT, SEVERABILITY AND VENUE: I understand that this is the entire Agreement between the undersigned and
Releasees, and that it cannot be modified or changed in any way by the representations or statements of Releasees or any employee or
agent of Releasees, or by the undersigned. I understand and agree that this Agreement is severable and that if any clause is found to be
invalid, the balance of the contract will remain in effect and will be valid and enforceable. I agree that any action will be brought in a court
in the City of Grande Prairie, Province of Alberta or alternatively, in a court of competent jurisdiction in the Province of Alberta. Any
disputes will be subject to and determined under the laws of the Province of Alberta.
THIS PERSONAL INFORMATIONS BEING COLLECTED UNDER THE AUTHORITY OF THE CITY OF GRANDE PRAIRIE AND WILL
BE USED AS A WAIVER FOR THE CITY OF GRANDE PRAIRIE. IT IS PROTECTED BY THE PRIVACY PROVISIONS OF THE
FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT. IF YOU HAVE ANY QUESTIONS ABOUT THE COLLECTION
CONTACT: FOIP COORDINATOR, CITY OF GRANDE PRAIRIE, PH. 780-538-0338 / FX. 780-539-1056.
I have read this entire document, understand it completely, and agree to be bound by its terms.
Legal Name (please print): ________________________________________________ Date: __________________________
Signature: _____________________________________________________________
AFFIDAVIT OF PARENT OR LEGAL GUARDIAN
I, the undersigned, declare that I am the parent of, or the legal guardian of, the below named minor, and
have the capacity to execute documents on behalf of such minor. I understand that as a condition to
participate in diving, the parent or legal guardian of the minor participant must sign certain legal documents,
including but not limited to Acknowledgements of Risks, Releases, and Indemnity Agreements. I am
signing those documents, freely, without any fraud or duress and acknowledge that I have read and
understand the same.
Legal Guardian Name: ___________________________________________________
(If is a minor)
Legal Guardian Signature: ________________________________________________ Date: __________________________
(If is a minor)